12/27 Rosie PMPS 266 - vomiting

[Thalia & Rosie]

I'm new to this forum, and a new sugarcat mom, so I'm sorry of I'm missing some technicalities. I just have a 911 situation.

Rosie is my 12yo DSH baby recently diagnosed with diabetes (17 December DX). She was started on Lantus (3U 2x daily) on 18 December. I haven't changed her diet yet, she's still on Hills k/d kidney & mobility which she was on before, for a bit of arthritis presence.

She started vomiting tonight (it's 18h30 here) and I don't know what to do or if it's a sign of anything. After her first vomit, I tested her BG and it was 266 (14.8 mmol/L) so my mind didn't go hypo. She vomited again after that - only sputum, no other stomach contents.

My BG meter can't do ketone tests - something I totally forgot to check for.

I need advice

 

[Heike & BInie]

I'm new to this forum, and a new sugarcat mom, so I'm sorry of I'm missing some technicalities. I just have a 911 situation.

Rosie is my 12yo DSH baby recently diagnosed with diabetes (17 December DX). She was started on Lantus (3U 2x daily) on 18 December. I haven't changed her diet yet, she's still on Hills k/d kidney & mobility which she was on before, for a bit of arthritis presence.

She started vomiting tonight (it's 18h30 here) and I don't know what to do or if it's a sign of anything. After her first vomit, I tested her BG and it was 266 (14.8 mmol/L) so my mind didn't go hypo. She vomited again after that - only sputum, no other stomach contents.

My BG meter can't do ketone tests - something I totally forgot to check for.

I need advice

Welcome! So great you are hometesting! Good job. If her BG is 266, she is not hypo. Did she eat fast? Might be the reason she vomited but hard to tell now. Does she act normal otherwise?

It would be helpful, if you can set up a spreadsheet, so the moderators can give you further advice. When is your next shot time? It's good not to give your local time but count the hours from the last shot.

3 IU is quite a huge dose to start with. I will tag some moderators, for further advice:
@Sienne and Gabby (GA) @Bandit's Mom @Wendy&Neko

Paws and fingers are crossed she is better soon!

 

[Bandit's Mom]

Hello and welcome to FDMB!

Sorry to hear that Rosie is vomiting! 18:30 would be how long after she got her insulin? When did she last eat?

What stage CKD is she at? Does she have a history of ketones?

 

[Thalia & Rosie]

Thanks for the response. I'm still getting familiar with how this forum works and didn't think I'd need to post anytime soon at all, so haven't gotten around to setting up the spreadsheet. Will do so soonest.

By posting my local time I meant to add that I can't phone Rosie's vet now. In my stress I left that out.

Her last shot ~ 10.5. hrs ago. Her next shot is only due in 1hr 20mins. She hasn't eaten much today - her feeding times are around the same periods apart, ~20-30 mins before her insulin shot. She's been sleeping most of the day. She could have had water too fast? Because her stomach contents are empty.

The vet prescribed 3 IU as a starting dose, with follow up in ~2 weeks from now. I don't know any better, just following his advice. I also don't know if Lantus insulin pens differ by country? I can't attach a photo it seems, but her insulin pen says "insulin glargine 100 U/ml"

 

[Thalia & Rosie]

Hello and welcome to FDMB!

Sorry to hear that Rosie is vomiting! 18:30 would be how long after she got her insulin? When did she last eat?

What stage CKD is she at? Does she have a history of ketones?

18h30 would have been ~10 and a bit hrs since her last dose. She doesn't have CKD, but the food she's on (k/d Kidney & mobility) was a recommendation from the vet ~ 3 months ago, before her diagnosis, to help her with her arthritis and support her kidneys generally as an elderly lady. We did suspect she had CKD before her blood tests came back and showed perfectly fine kidneys.

Her last blood test did show slightly elevated liver enzymes (~2 weeks ago) but she had just recently come off antibiotics for a cold, so the vet couldn't say anything conclusive about the liver enzymes.

 

[Jodey&Eddie&Blue]

Welcome to FDMB, hoping @Wendy&Neko will also be able to chime in. I agree with @Heike & BInie that 3u is really very high to start on insulin but that's where you are now. Do you have access to Cerenia (anti-vomitting) or Ondansetron (anti-nausea)?
Hope Rose feels better soon.

 

[Bandit's Mom]

Her last shot ~ 10.5. hrs ago. Her next shot is only due in 1hr 20mins. She hasn't eaten much today - her feeding times are around the same periods apart, ~20-30 mins before her insulin shot. She's been sleeping most of the day. She could have had water too fast? Because her stomach contents are empty.

Does she not get food between shots or did she not want to eat today? Long gaps between meals can result in stomach acid build up which can give you foamy clear puke.

I also don't know if Lantus insulin pens differ by country? I can't attach a photo it seems, but her insulin pen says "insulin glargine 100 U/ml"

Lantus is one of the brand names for Insulin Glargine.

 

[Bandit's Mom]

She doesn't have CKD, but the food she's on (k/d Kidney & mobility) was a recommendation from the vet ~ 3 months ago, before her diagnosis, to help her with her arthritis and support her kidneys generally as an elderly lady. We did suspect she had CKD before her blood tests came back and showed perfectly fine kidneys.

Many vets jump to "prescription" food even when there's really no need – both with diabetes and CKD. The only time a cat might need K/D is when they're in stage 4 or end stage CKD. Otherwise, you want to feed foods that are both low carb (for the diabetes) and low phosphorus (for the CKD). It used to be thought that a low protein diet is beneficial for cats with kidney disease but newer research shows that it's much more important to restrict phosphorus. That restricting protein at low levels of CKD just leads to muscle wasting. Look for foods with carbs under 10% and the dry matter for phosphorus under 250mg. Treating the diabetes will in turn help the kidney disease by reducing the strain on the kidneys that diabetes causes.

Like with diabetes in humans, diet is an essential part of diabetes treatment in cats. Feeding carbs to a diabetic cat in treatment, is like trying to put out a fire with one hand while adding fuel to it with the other! Changing her to a low carb diet could make a big difference to her blood sugar. So any transition in diet, when already on insulin, has to be made gradually and with careful monitoring of the BG (with home testing) and insulin requirements. We have had cats that have gone off insulin with just a change from high carb kibble to a low carb canned diet.

Her last blood test did show slightly elevated liver enzymes (~2 weeks ago) but she had just recently come off antibiotics for a cold, so the vet couldn't say anything conclusive about the liver enzymes.

I think I've read that a diabetic cat can have slightly elevated liver enzymes. I'm not sure. You needn't worry about a slight elevation though.

 

[Thalia & Rosie]

Does she not get food between shots or did she not want to eat today? Long gaps between meals can result in stomach acid build up which can give you foamy clear puke.



Lantus is one of the brand names for Insulin Glargine.

Thanks for the Lantus info! As you can see I'm a noob at all of this, still. It's very overwhelming.

She has access to her food all day. She gets a specific amount in the mornings and evenings, but she never finishes it all in one sitting so she sometimes nibbles throughout the day. She didn't seem to nibble much today, and her vomit is exactly as you describe - foamy clear goopy!

 

[Thalia & Rosie]

Many vets jump to "prescription" food even when there's really no need – both with diabetes and CKD. The only time a cat might need K/D is when they're in stage 4 or end stage CKD. Otherwise, you want to feed foods that are both low carb (for the diabetes) and low phosphorus (for the CKD). It used to be thought that a low protein diet is beneficial for cats with kidney disease but newer research shows that it's much more important to restrict phosphorus. That restricting protein at low levels of CKD just leads to muscle wasting. Look for foods with carbs under 10% and the dry matter for phosphorus under 250mg. Treating the diabetes will in turn help the kidney disease by reducing the strain on the kidneys that diabetes causes.

Like with diabetes in humans, diet is an essential part of diabetes treatment in cats. Feeding carbs to a diabetic cat in treatment, is like trying to put out a fire with one hand while adding fuel to it with the other! Changing her to a low carb diet could make a big difference to her blood sugar. So any transition in diet, when already on insulin, has to be made gradually and with careful monitoring of the BG (with home testing) and insulin requirements. We have had cats that have gone off insulin with just a change from high carb kibble to a low carb canned diet.



I think I've read that a diabetic cat can have slightly elevated liver enzymes. I'm not sure. You needn't worry about a slight elevation though.

Thanks, that's useful info. I've been reading up a lot the last few days about diet, so I'm definitely getting there. Our vet may just have old school info on diets.

Rosie just started eating now (40 mins post vomiting) so maybe she isn't nauseous? Idk.

Is it normal for cats to eat less on insulin, or because of diabetes? Or is this something I should just closely monitor for now? Should I start keeping nausea/vomiting meds on hand?

 

[Bandit's Mom]

She has access to her food all day. She gets a specific amount in the mornings and evenings, but she never finishes it all in one sitting so she sometimes nibbles throughout the day. She didn't seem to nibble much today, and her vomit is exactly as you describe - foamy clear goopy!

Could you offer her a little food now and see if she will eat it? You normally do not want to feed in the 2 hour window before the shot (so that you get a preshot reading that is not influenced by food), but it's possible that she is vomiting because of acid build up from not eating. Besides, she was high enough at +10.5.

Do you know if she had ketones at diagnosis?

As you can see I'm a noob at all of this, still. It's very overwhelming.

It is indeed overwhelming at first! We've all been there, so feel free to ask any questions you might have!

 

[Thalia & Rosie]

Welcome to FDMB, hoping @Wendy&Neko will also be able to chime in. I agree with @Heike & BInie that 3u is really very high to start on insulin but that's where you are now. Do you have access to Cerenia (anti-vomitting) or Ondansetron (anti-nausea)?
Hope Rose feels better soon.

It's what the vet prescribed, and I don't know any better. I don't even have family with diabetes. So this is all very new to me.

Unfortunately we don't have any nausea meds for Rosie on hand. We've never needed to, and her diagnosis is very new.

 

[Bandit's Mom]

Rosie just started eating now (40 mins post vomiting) so maybe she isn't nauseous? Idk.

That's great! Always good when they eat.

Is it normal for cats to eat less on insulin, or because of diabetes?

Actually, unregulated diabetic cats cannot process their food which is why they are always starving and lose weight even after eating more. Once their blood sugar starts coming down to better levels, that ravenous appetite reduces.

Should I start keeping nausea/vomiting meds on hand?

If it's possible, its always good to have some on hand. Ondansetron for nausea and Cerenia (maropitant) for vomiting. I'm in India and we don't get Cerenia here. Vets here prescribe Ondansetron for both nausea and vomiting!

 

[Sienne and Gabby (GA)]

Please make sure that your cat hasn't gotten into anything she should not have. Holiday plants (e.g, poinsettia) can be toxic. Likewise, were there any holiday foods that Rosie could have been "snacking" on?

Is Rosie looking like she's interested in eating or is she avoiding food? If she looks interested, takes a lick or two then walks away, she may be nauseated. You may want to try a bland food -- something like baby food providing its meat only (no onions, garlic, etc.) and see if she can tolerate that.

Cats can get an upset stomach/stomach flu just like humans. It sounds like she's trying food. Don't give her a full meal. Try small, more frequent amounts. If the vomiting persists, it may mean a visit to your vet or to the emergency vet. You don't want Rosie to go without food for more than a couple of days.

 

[Thalia & Rosie]

Could you offer her a little food now and see if she will eat it? You normally do not want to feed in the 2 hour window before the shot (so that you get a preshot reading that is not influenced by food), but it's possible that she is vomiting because of acid build up from not eating. Besides, she was high enough at +10.5.

Do you know if she had ketones at diagnosis?


It is indeed overwhelming at first! We've all been there, so feel free to ask any questions you might have!

I didn't know you shouldn't feed in the two hours pre-shot window. I'm also still reading up about testing windows and best practices, so I'm slowly getting the hang of it.

She just ate a few kibbles in her bowl which gave me some relief. I was worried she wouldn't eat at all. I doubt she's going to eat now, when I give her her evening feed, considering what her appetite looks like.

The only wet food I have on hand is royal canin "digestive" and hills "aging". I've been scared of giving her that because of stuff I've read about sugars in wet food gravies. But the packets don't give a carb or sugar content measurement. So I don't know if it's safe.

 

[Thalia & Rosie]

Please make sure that your cat hasn't gotten into anything she should not have. Holiday plants (e.g, poinsettia) can be toxic. Likewise, were there any holiday foods that Rosie could have been "snacking" on?

Is Rosie looking like she's interested in eating or is she avoiding food? If she looks interested, takes a lick or two then walks away, she may be nauseated. You may want to try a bland food -- something like baby food providing its meat only (no onions, garlic, etc.) and see if she can tolerate that.

Cats can get an upset stomach/stomach flu just like humans. It sounds like she's trying food. Don't give her a full meal. Try small, more frequent amounts. If the vomiting persists, it may mean a visit to your vet or to the emergency vet. You don't want Rosie to go without food for more than a couple of days.

I've had a think and I doubt she's been in contact with toxic things. We did just come back from visiting the parents, and Rosie needs to come with now for her insulin shots. But she's used to traveling around with me. My parents also have three cats that she loves to be around.

Considering your advice, it does seem like she may be nauseous. She went to her food bowl and ate a little bit, and then went to lie down again.

Her evening feed time is coming up so I'll try see if she'll eat a little bit more before she gets her scheduled shot.

 

[Thalia & Rosie]

I'll remove the 911 tag on the post because for now it feels like we're not in an immediate 911 situation?

Thanks for everyone's SUPER generous time and responses. Rosie and I are grateful

 

[Karen and Chispa (GA)]

Hi Thalia, and welcome to the FDMB. It IS overwhelming at first, but there are so many great people who are here and ready to help.

I want to second what @Bandit's Mom has said about about the prescription CKD food. It is SUPER high in carbs -- something like 24% last time I checked!! You'll want to transition her off of it, but as you transition, be aware that her insulin needs will decrease in tandem with the carb content of the food. Hopefully you're getting the hang of home testing so you can keep track of her glucose throughout each cycle and decrease the dose as her numbers come down. (More about that here: https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/)

It sounds like you're off to a great start, so keep up the good work, and don't hesitate to check in here whenever you have a question. Good luck!

 

[Wendy&Neko]

Hello and welcome to you and sweet Rosie.

Seconding what Karen said, changing from high carb to low carb food should be done very slowly. Both to help her tummy deal with changes, as well as being able to see what the change is doing to the blood sugars. There is a good chance her insulin needs will reduce a lot. For reference, on this forum, we'll start a cat eating dry food on 1 unit of Lantus.

I have a kitty that is a grazer, and she will often present me with some foamy vomit if she forgets to go eat for too long.

You can get ketones urine testing sticks at most pharmacies in the diabetes section, also used by people on a keto diet. Tips to catch and test a urine sample

There are other options for arthritis we can talk about besides food. Depending on how bad it is. The newest medication, a shot, is called Solensia. Is it available in RSA yet? There are other things you can add to her food as well.